Periprosthetic Fractures in Total Elbow Replacement: Classification and Current Treatment Algorithm

  • E. Bellato
  • I. Zorzolo
  • L. Comba
  • A. Marmotti
  • G. Ferrero
  • F. Castoldi


Periprosthetic fractures are rare with an estimated prevalence of between 5% and 29%. They can be intraoperative or postoperative and, in cases of the latter, can occur due to either a single traumatic event or secondary to massive loss of bone stock. The Mayo classification distinguishes between three types of fractures: periarticular (a), around the prosthetic stem (b), and distal to the prosthetic stem (c). Among the type B, subtypes 1 through 3 identify the bone stock quality. This classification helps the surgeon decide what type of treatment is most suitable in each case. Some patients can be treated nonoperatively, but most of the fractures usually need fixation, sometimes augmented with bone graft.


Periprosthetic elbow fractures Revision surgery Fixation Allograft composite prosthesis 


  1. 1.
    O’Driscoll SW, Morrey BF. Periprosthetic fractures about the elbow. Orthop Clin North Am. 1999;30:319–25.CrossRefPubMedGoogle Scholar
  2. 2.
    Morrey BF, Adams RA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. J Bone Joint Surg Am. 1992;74:479–90.CrossRefPubMedGoogle Scholar
  3. 3.
    Hildebrand KA, Patterson S, Regan W, et al. Functional outcome of semiconstrained total elbow arthroplasty. J Bone Joint Surg Am. 2000;82–A:1379–86.CrossRefGoogle Scholar
  4. 4.
    Capone A, Congia S, Civinini R, Marongiu G. Periprosthetic fractures: epidemiology and current treatment. Clin Cases Miner Bone Metab. 2017;14:189–96.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Foruria AM, Sanchez-sotelo J. Periprosthetic elbow fractures. In: Morrey’s the elbow and its disorders. 5th ed. Philadelphia: Saunders; 2018. p. 1232.Google Scholar
  6. 6.
    Morrey BF, Bryan RS. Revision total elbow arthroplasty. J Bone Joint Surg Am. 1987;69(4):523–32.CrossRefPubMedGoogle Scholar
  7. 7.
    Foruria AM, Sanchez-Sotelo J, Oh LS, et al. The surgical treatment of periprosthetic elbow fractures around the ulnar stem following semiconstrained total elbow arthroplasty. J Bone Joint Surg. 2011;93:1399–407.CrossRefPubMedGoogle Scholar
  8. 8.
    Duncan CP, Masterson EL, Masri BA. Impaction allografting with cement for the management of femoral bone loss. Orthop Clin North Am. 1998;29:297–305.CrossRefPubMedGoogle Scholar
  9. 9.
    Mansat P, Adams RA, Morrey BF. Allograft-prosthesis composite for revision of catastrophic failure of total elbow arthroplasty. J Bone Joint Surg Am. 2004;86-A:724–35.CrossRefGoogle Scholar
  10. 10.
    Vergidis P, Greenwood-Quaintance KE, Sanchez-Sotelo J, et al. Implant sonication for the diagnosis of prosthetic elbow infection. J Shoulder Elb Surg. 2011;20:1275–81.CrossRefGoogle Scholar
  11. 11.
    Loebenberg MI, Adams R, O’Driscoll SW, Morrey BF. Impaction grafting in revision total elbow arthroplasty. J Bone Joint Surg Am. 2005;87:99–106.CrossRefPubMedGoogle Scholar
  12. 12.
    Morrey BF, Adams RA. Semiconstrained elbow replacement for distal humeral nonunion. J Bone Joint Surg Br. 1995;77:67–72.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Cobb TK, Morrey BF. Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. J Bone Joint Surg Am. 1997;79:826–32.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    McKee MD, Pugh DMW, Richards RR, et al. Effect of humeral condylar resection on strength and functional outcome after semiconstrained total elbow arthroplasty. J Bone Joint Surg Am. 2003;85–A:802–7.CrossRefGoogle Scholar
  15. 15.
    Papagelopoulos PJ, Morrey BF. Treatment of nonunion of olecranon fractures. J Bone Joint Surg Br. 1994;76:627–35.CrossRefPubMedGoogle Scholar
  16. 16.
    Marra G, Morrey BF, Gallay SH, et al. Fracture and nonunion of the olecranon in total elbow arthroplasty. J Shoulder Elb Surg. 2006;15:486–94.CrossRefGoogle Scholar
  17. 17.
    Dehghan N, Chehade M, Mckee MD, Frcs C. Current perspectives in the treatment of periprosthetic upper extremity fractures. J Orthop Trauma. 2011;25(Suppl 2):S71–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Sanchez-Sotelo J, O’Driscoll S, Morrey BF. Periprosthetic humeral fractures after total elbow arthroplasty: treatment with implant revision and strut allograft augmentation. J Bone Joint Surg Am. 2002;84-A:1642–50.CrossRefGoogle Scholar
  19. 19.
    Kamineni S, Morrey BF. Proximal ulnar reconstruction with strut allograft in revision total elbow arthroplasty. J Bone Joint Surg Am. 2004;86–A:1223–9.CrossRefGoogle Scholar
  20. 20.
    Gie GA, Linder L, Ling RS, et al. Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone Joint Surg Br. 1993;75:14–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Lucas RM, Hsu JE, Gee AO, et al. Impaction autografting: bone-preserving, secure fixation of a standard humeral component. J Shoulder Elb Surg. 2016;25:1787–94.CrossRefGoogle Scholar
  22. 22.
    Morrey ME, Sanchez-Sotelo J, Abdel MP, Morrey BF. Allograft-prosthetic composite reconstruction for massive bone loss including catastrophic failure in total elbow arthroplasty. J Bone Joint Surg Am. 2013;95:1117–24.CrossRefPubMedGoogle Scholar
  23. 23.
    Figgie HE, Inglis AE, Mow C. Total elbow arthroplasty in the face of significant bone stock or soft tissue losses. J Arthroplast. 1986;1:71–81.CrossRefGoogle Scholar
  24. 24.
    Franke A, Bieler D, Hentsch S, et al. Reconstruction of an elbow joint after blast injury by arthroplasty with a custom-made modified total elbow prosthesis: a case report. J Shoulder Elb Surg. 2014;23:e81–7.CrossRefGoogle Scholar
  25. 25.
    Tang X, Guo W, Yang R, et al. Custom-made prosthesis replacement for reconstruction of elbow after tumor resection. J Shoulder Elb Surg. 2009;18:796–803.CrossRefGoogle Scholar
  26. 26.
    Capanna R, Muratori F, Campo FR, et al. Modular megaprosthesis reconstruction for oncological and non-oncological resection of the elbow joint. Injury. 2016;47:S78–83.CrossRefPubMedGoogle Scholar
  27. 27.
    Prkic A, Welsink C, The B, et al. Why does total elbow arthroplasty fail today? A systematic review of recent literature. Arch Orthop Trauma Surg. 2017.Google Scholar
  28. 28.
    Tokunaga D, Hojo T, Ohashi S, et al. Periprosthetic ulnar fracture after loosening of total elbow arthroplasty treated by two-stage implant revision: a case report. J Shoulder Elb Surg. 2006;15:23–6.CrossRefGoogle Scholar
  29. 29.
    Fang C, Yan CH, Yee D, et al. Restoration of humeral bone stock two years after internal fixation of a periprosthetic fracture with a loose stem: a report of two cases. JBJS Case Connect. 2017;7:e17.CrossRefPubMedGoogle Scholar
  30. 30.
    Kawano Y, Okazaki M, Ikegami H, et al. The “docking” method for periprosthetic humeral fracture after total elbow arthroplasty: a case report. J Bone Joint Surg. 2010;92:1988–91.CrossRefPubMedGoogle Scholar
  31. 31.
    Hanyu T, Nakazono K, Ishikawa H. Humeral shaft fracture after a total elbow arthroplasty. J Shoulder Elb Surg. 1998;7:541–4.CrossRefGoogle Scholar
  32. 32.
    Kent ME, Sinopidis C, Brown DJ, Frostick SP. The locking compression plate in periprosthetic humeral fractures: a review of two cases. Injury. 2005;36:1241–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Carroll EA, Lorich DG, Helfet DL. Surgical management of a periprosthetic fracture between a total elbow and total shoulder prostheses: a case report. J Shoulder Elb Surg. 2009;18:e9–e12.CrossRefGoogle Scholar
  34. 34.
    Kieser DC, Fraser T, Bal CM. The allograft sleeve: a case report of the surgical management of an interprosthetic fracture between a shoulder and elbow joint replacement. J Shoulder Elb Surg. 2011;20:e4–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • E. Bellato
    • 1
    • 2
  • I. Zorzolo
    • 2
  • L. Comba
    • 2
  • A. Marmotti
    • 1
  • G. Ferrero
    • 1
  • F. Castoldi
    • 1
    • 2
  1. 1.Department of Orthopaedic SurgerySan Luigi Gonzaga Hospital, University of Turin Medical SchoolTurinItaly
  2. 2.University of Turin Medical SchoolTurinItaly

Personalised recommendations